COVID-19 Vaccination and Predictive Factors in Immigrants to Europe: A Systematic Review and Meta-Analysis

Vaccination plays a pivotal role in the control of infectious disease outbreaks. Hesitancy/refusal of the vaccine by immigrants poses a serious threat to their and society's health. We reviewed studies regarding COVID-19 vaccine uptake in Europe by first-generation immigrants. A systematic review (PROSPERO: CRD42023432142), conducted until 31 October 2023 using Web of Science, PubMed, and Scopus, identified 295 potential articles. Of these, 16 conducted on 2,009,820 immigrants in nine European countries met the eligibility criteria. Most studies were of medium/high quality according to the Newcastle-Ottawa Scale adapted for observational studies. Factors that affected the uptake or hesitancy/refusal to vaccinate, with particular regard to gender, age, and country of origin, were examined. The meta-analysis of eight studies revealed that the pooled estimated prevalence of COVID-19 vaccine uptake in first-generation immigrants was 71.3% (95% CI: 70.0-72.5%), corresponding to 13.3% less than the host country population (95% CI: 10.2-16.4%). Limitations of included studies and this review were deeply discussed, highlighting the need for further research on the effect of acculturation on second-generation immigrants. European governments need to ensure equal availability of COVID-19 and other health-saving vaccines to all immigrants in the future by overcoming cultural barriers, building trust in institutions, and improving communication.

Determinants of HPV vaccine uptake intentions in Chinese clinical interns: an extended theory of planned behavior approach

Background

This study aims to utilize the extended Theory of Planned Behavior (TPB) model to examine the intentions of clinical interns in China towards Human papillomaviruses (HPV) vaccination. It also fills a significant gap in the literature concerning vaccine acceptance in this specific population.

Methods

This cross-sectional study was carried out with clinical interns in Shandong Province, China, with a total of 1,619 participants. Data were collected through self-reported questionnaires, including demographic characteristics, TPB variables, and HPV-related health knowledge. Hierarchical regression analysis was employed to identify key factors influencing vaccination intentions, and Structural Equation Modeling (SEM) was used to analyze the interrelationships between these factors.

Results

This study initially identified key predictors affecting clinical interns' intentions to receive the HPV vaccine through hierarchical regression analysis. The preliminary model, which accounted for demographic factors, revealed foundational impacts of household income and HPV-related clinical experience on intentions. After integrating TPB variables-attitude, subjective norm, perceived behavioral control, and HPV-related health knowledge-the model's explanatory power was enhanced to 37.30%. SEM analysis focused on the interplay among TPB constructs and extended variables, confirming their significance in forming vaccination intentions, with subjective norm having the most substantial impact (β = 0.375, p < 0.001). The extended TPB model explained over half of the variance in vaccination intentions, substantiating the hypotheses and revealing the psychological determinants behind clinical interns' decision-making for HPV vaccination.

Conclusion

The extended TPB model from this study effectively explains the vaccination intentions among clinical interns for HPV, offering theoretical support for public health strategies and educational interventions targeting this group. These findings are of significant importance for public health practice and future health promotion strategies.

The Association between Message Framing and Intention to Vaccinate Predictive of Hepatitis A Vaccine Uptake

As ongoing, sporadic outbreaks of hepatitis A virus (HAV) infections present public health challenges, it is critical to understand public perceptions about HAV, especially regarding vaccination. This study examines whether message framing changes the intention to vaccinate against HAV and self-reported vaccine behavior. Using a randomized controlled trial (N = 472) in February 2019 via Amazon Mechanical Turk, participants were randomized to one of four HAV vaccination message groups or a no-message control group. The message groups varied in their emphasis on the nature of outcomes (gain versus loss) and for whom (individual versus collective). The message frames were compared by intention to vaccinate, differences in message characteristics, and behavioral determinants. There was no difference in intention to vaccinate between gain- versus loss-framed messages (MD = 0.1, 95% CI = -0.1, 0.3) and individual- versus collective-framed messages (MD = 0.1, 95% CI = -0.1, 0.3). The intention to vaccinate against HAV in the no-message control group was very similar to that in the message groups. However, gain-framed messages were rated more positively in valence than loss-framed messages (MD = -0.5, 95% CI = -0.7, -0.3), which may be helpful for cultivating a positive public perception of HAV vaccination. The study also highlights the importance of comparing message frames to a no-message control in designing health communication messaging promoting HAV vaccination.

What drives the vaccination intention against COVID-19? Application of EPPM, TAM, and theories of risk assessment

Vaccines are widely used to fight against COVID-19. However, COVID-19 vaccine hesitancy appears as some individuals are concerned with COVID-19 vaccines. This study investigates the vaccination intention against COVID-19 in China with the Extended Parallel Process Model (EPPM), Technology Acceptance Model (TAM), and theories of risk information assessment. Results showed that the formation mechanism of vaccination intention could be considered a psychological process, as subjective knowledge was a primary influence on correspondents' weighting of both the potentially positive (usefulness) and negative effects (threat) of vaccination. This unequal consideration then resulted in different levels of fear arousal between subjects. Driven by usefulness/threat perception and fear, people conducted different decision strategies, so-called analytical assessment, and experiential assessment to make vaccination decision. In addition to the direct effects of experiential assessment on vaccination intention, two decision strategies and fear arousal also affected people's vaccination intention through the mediation role of vaccination attitude. For policymakers and stakeholders, this study provides a knowledge base for confidence-building, and emotional guidance concerning against COVID-19 vaccination.

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

Psychological Factors of Vaccination Intent among Healthcare Providers, Parents, and Laypeople

The interrelatedness of social-structural aspects and psychological features with vaccination intention provides the context to explore personal psychological features related to vaccination. Specifically, we focused on general decision making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. Our study aimed to map the function (promotive, protective, risk, vulnerability) of a set of personal psychological aspects in the intention to vaccinate among people holding different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and laypeople, within the post-pandemic context. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from -0.128 to -0.983, all ps < 0.01). The main results indicate that, regardless of the sample/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate: for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system, play such roles; for HPs, the experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. Our findings provide insights into the function of psychological factors of vaccination intention across different social roles, particularly healthcare providers, parents, and laypeople, and emphasize the need for tailored immunization interventions in the post-pandemic landscape.

Factors associated with parental intention to vaccinate their child against influenza, Finland, February to March, 2022: a web-based survey

BackgroundInfluenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences.AimTo assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children.MethodsWe conducted a web-based survey among parents (n = 17,844) of randomly selected eligible children (aged 6 months-6 years) in February-March 2022 in five Finnish municipalities from regions of high and low coverage. Logistic regressions were used to determine associations between vaccination intention and e.g. sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.ResultsParticipation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent's education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64%, and realised vaccination 51%.ConclusionDespite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.

Who is motivated to accept a booster and annual dose? A dimensional and person-centered approach

The transmissibility of new COVID-19 variants and decreasing efficacy of vaccines led authorities to recommend a booster and even an annual dose. However, people's willingness to accept new doses varied considerably. Using two independent longitudinal samples of 4596 (Mean age = 53.6) and 514 (Mean age = 55.9) vaccinated participants, we examined how people's (lack of) vaccination motivation for their first dose was associated with their intention to get a booster (Sample 1) and an annual dose (Sample 2) several months later (Aim 1). We also aimed to capture the impact of the motivational heterogeneity on these intentions by capitalizing on participants' different motivational profiles collected at baseline (Aim 2). Across both samples, autonomous motivation, controlled motivation, and distrust-based amotivation were uniquely related to, respectively, higher, lower, and even lower booster and annual dose intentions. Further, a two-step clustering procedure revealed five profiles, with the profiles characterized by higher autonomous motivation (i.e. Good Quality and High Quantity profiles) reporting the highest vaccination intentions and the profile characterized by the highest number of obstacles (i.e. Global Amotivated profile) yielding the lowest vaccination intentions. These results stress the critical need to support citizens' volitional endorsement of vaccination to harvest long-term benefits with respect to COVID-19.

Factors Associated with COVID-19 Vaccination Promptness after Eligibility in a North Carolina Longitudinal Cohort Study

Many studies identified factors associated with vaccination intention and hesitancy, but factors associated with vaccination promptness and the effect of vaccination intention on vaccination promptness are unknown. This study identified factors associated with COVID-19 vaccination promptness and evaluated the role of vaccination intention on vaccination promptness in 1223 participants in a community-based longitudinal cohort study (June 2020 to December 2021). Participants answered questions regarding COVID-19 vaccination intention, vaccination status, and reasons for not receiving a vaccine. The association of baseline vaccine hesitancy with vaccination was assessed by the Kaplan-Meier survival analysis. Follow-up analyses tested the importance of other variables predicting vaccination using the Cox proportional hazards model. Older age was associated with shorter time to vaccination (HR = 1.76 [1.37-2.25] 85-year-old versus 65-year-old). Lower education levels (HR = 0.80 [0.69-0.92]), household incomes (HR = 0.84 [0.72-0.98]), and baseline vaccination intention of 'No' (HR = 0.16 [0.11-0.23]) were associated with longer times to vaccination. The most common reasons for not being vaccinated (N = 58) were vaccine safety concerns (n = 33), side effects (n = 28), and vaccine effectiveness (n = 25). Vaccination campaigns that target populations prone to hesitancy and address vaccine safety and effectiveness could be helpful in future vaccination rollouts.

Exploring public sentiment and vaccination uptake of COVID-19 vaccines in England: a spatiotemporal and sociodemographic analysis of Twitter data

Objectives

Vaccination is widely regarded as the paramount approach for safeguarding individuals against the repercussions of COVID-19. Nonetheless, concerns surrounding the efficacy and potential adverse effects of these vaccines have become prevalent among the public. To date, there has been a paucity of research investigating public perceptions and the adoption of COVID-19 vaccines. Therefore, the present study endeavours to address this lacuna by undertaking a spatiotemporal analysis of sentiments towards vaccination and its uptake in England at the local authority level, while concurrently examining the sociodemographic attributes at the national level.

Methods

A sentiment analysis of Twitter data was undertaken to delineate the distribution of positive sentiments and their demographic correlates. Positive sentiments were categorized into clusters to streamline comparison across different age and gender demographics. The relationship between positive sentiment and vaccination uptake was evaluated using Spearman's correlation coefficient. Additionally, a bivariate analysis was carried out to further probe public sentiment towards COVID-19 vaccines and their local adoption rates.

Result

The results indicated that the majority of positive tweets were posted by males, although females expressed higher levels of positive sentiment. The age group over 40 dominated the positive tweets and exhibited the highest sentiment polarity. Additionally, vaccination uptake was positively correlated with the number of positive tweets and the age group at the local authority level.

Conclusion

Overall, public opinions on COVID-19 vaccines are predominantly positive. The number of individuals receiving vaccinations at the local authority level is positively correlated with the prevalence of positive attitudes towards vaccines, particularly among the population aged over 40. These findings suggest that targeted efforts to increase vaccination uptake among younger populations, particularly males, are necessary to achieve widespread vaccination coverage.

Examining health sciences students' intention to uptake COVID-19 vaccination using the theory of planned behavior

To examine the association between the theory of planned behavior (TPB) constructs and Health Sciences students' intentions to receive COVID-19 vaccination. A cross-sectional study was conducted in Saudi Arabia by recruiting Health Sciences students as participants. Using Structural Equation Modeling (SEM), the proposed TPB model was evaluated. The sample of 505 individuals consisted of more males (n = 275; 54.5%) than females and was relatively young (88% were between the ages of 18 and 30). The suggested TPB model explained 78.2% of the variation in intention to get COVID-19 immunization. We found that greater levels of perceived behavioral control (β = 1.58, p < .001) and attitude (β = .44, p < .001) strongly predicted increased vaccination intentions. The subjective norm construct was not a significant predictor of vaccination intentions (β = 0.06, p = .34). The findings of this study indicate that the TPB can be utilized effectively to obtain insight into the factors associated with COVID-19 adherence and help in the development of effective COVID-19 intervention strategies.

COVID-19 vaccination intention among nursing, medical, and dental students: A systematic review and meta-regression analysis

The introduction of the COVID-19 vaccine amidst the pandemic has heralded a paradigm shift. Healthcare students in nursing, medicine, and dentistry must have positive attitudes owing to their future role in vaccine recommendations to the public and patients. This meta-regression analysis assessed the differences in COVID-19 vaccination intention (VI) of nursing, medical, and dental students. Medline/PubMed, EMBASE, CINAHL, Cochrane Library, and Korean MBASE were searched for eligible studies. Quality was assessed by the Joanna Briggs Institute's quality appraisal. Forty-one studies were included in the final analysis, and the estimation of pooled prevalence (68%) and relevant factors were assessed. Dental students were found to have the lowest VI (57%), which significantly (p = .018) differed from that of nursing students (64%). Countries in South-East Asia and those with high income levels were found to have high VI. Therefore, global vaccine programs for healthcare students should be prepared considering their geographical and economic status.

Waiting for the COVID-19 vaccine: vaccine intention, trust in authorities and information needs in an Italian sample

The COVID-19 vaccine development timelines offered a unique opportunity to explore the public's vaccine intention in an unusual situation characterised by great uncertainty about the vaccine's features and the disease it intended to prevent. To advance our knowledge of vaccine intention mechanisms under these unusual circumstances, to plan effective vaccination strategies, and to better direct communication efforts in similar scenarios, this study explored i) COVID19-related information needs, information-seeking behaviours, and perceived trustworthiness of news media; ii) COVID-19 vaccination intention and its determinants, during the first wave of COVID-19 pandemic in Italy. In particular, it was investigated whether and to what extent the perception of severity and susceptibility to the infection, trust in authorities, and demographics shaped people's vaccine intention. Between April and May 2020 in a cross-sectional study, 1373 Italian participants completed an online survey measuring demographic features, perception of the disease severity, disease risk perception, COVID19-related worry, disease-related information needs and behaviours, vaccination intention, and level of trust in authorities and news media. The leading information needs were the COVID-19 incubation period and transmission modalities, with the majority of people actively looking for information from one to three times a day. Despite uncertainty around the details of a COVID-19 vaccination, 68% of participants reported intending to be vaccinated for COVID-19. Greater COVID-19 vaccination intention was associated with having a regular history of seasonal flu vaccine, a greater COVID19-related worry, a higher perception of disease severity, and a higher trust in the Government. These findings further our understanding of vaccine intention in a pandemic scenario where a vaccine is still hypothetical and provide valuable information on the public's representation of the infection and future acceptance of a vaccine to inform the development of communication interventions aiming to maximise adherence to vaccination programmes and to modify disease-related dysfunctional representations.

Providing freedom or financial remuneration? A cross-sectional study on the role of monetary and legal incentives on COVID-19 further booster vaccination intention in the Italian context

Vaccine hesitancy became a more and more important issue during the COVID-19 pandemic. Due to the emergence of new variants, many international health agencies have already begun administering booster doses of the vaccine in response to these threats. Studies have emphasized the effectiveness of different types of incentive-based strategies to increase vaccination behaviors. The purpose of the present study was to identify the correlation between different types of incentives (legal or financial) with people's intentions to get a COVID-19 booster vaccine. We conducted a cross-sectional study between 29 January 2022 and 03 February 2022. An online quantitative survey was carried out in Italy. One thousand and twenty-two Italian adults were recruited by a professional panel provider. Descriptive statistics were computed for the five variables concerning the incentives (monetary, tax, fee, health certification, travel) toward vaccination. A general linear model (GLM) was then computed to compare the scores of the five different variables within the subjects. The general linear model showed a significant within-subjects main effect. Post-hoc comparisons showed that among the financial incentive, the monetary reward is rated lower than all the others. Tax and fees both resulted lower than both the legal incentives. Finally, COVID-19 health certification and travel did not result significantly different from each other. This study offers an important contribution to public policy literature and to policymakers in their efforts to explain and steer booster vaccination acceptance while facing an ongoing pandemic.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Secondary Risk in COVID-19 Vaccination Intentions: A Theoretical Contribution to the Protection Motivation Paradigm

This study presents an original model that features the emotion of fear of COVID-19 as a direct effect on vaccination intentions. A central research question addressed in the study is what roles do the emotion of fear of contracting COVID-19 and the threat posed by uptake of the COVID-19 vaccination play in levels of vaccination intention? The study used a structural equation model (SEM) and applied the SmartPLS 3.2.6 data analysis tool for model estimation and multivariate analysis variables. A key finding is that vaccination resistance is strongest when fear of COVID-19 is lower, and vaccination threat higher. Vaccination threat appraisal and vaccination intention were found to have a negative relationship. Response costs at higher levels lessen motivation for COVID-19 vaccination. Research implications include research-based targeting of differing segments by their primary fear, either fear of COVID-19 or of the preventative vaccine.

Factors Affecting the Public Intention to Repeat the COVID-19 Vaccination: Implications for Vaccine Communication

Although most of the pandemic-related mandatory restrictions have been lifted or eased, vaccination is still recommended as an effective measure to minimize the damage from COVID-19 infection. Since COVID-19 eradication is unlikely, it is necessary to understand the factors affecting the public's vaccination intention when COVID-19 vaccination is continuously recommended. This study aims to explore the factors that affect the intention to repeat the COVID-19 vaccination in South Korea. An online survey was conducted in January 2022 with adults living in Gyeonggi-do, South Korea. In a hierarchical logistic regression analysis, sociodemographic factors, COVID-19 infection-related factors, COVID-19 vaccination-related factors, sociocultural factors, and communication factors were taken into account. In this study, more than three-quarters (78.1%) of Koreans were willing to repeat the COVID-19 vaccination. People who had high-risk perceptions, had been vaccinated against COVID-19 at least once, had more authoritarian attitudes, regarded the vaccination as a social responsibility, and had positive attitudes toward health authorities' regular briefings were more likely to repeat the vaccination. In contrast, those who directly or indirectly experienced COVID-19 vaccine side effects and who showed psychological reactance against the government's vaccination recommendation were less likely to repeat the vaccination. Our research indicates that empathetic communication, promotion of the prosocial aspect of vaccination, and regular and transparent provision of vaccine information are essential for promoting the intention to repeat the COVID-19 vaccination.

Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part III: COVID-19 vaccination intentions

OBJECTIVES

This cross-sectional study was to determine the coronavirus disease 2019 (COVID-19) vaccination intention of clinical dental hygienists in South Korea and the factors that influence vaccination intention.

METHODS

COVID-19 vaccination intention of the 500 participants was confirmed through a survey including the following options: 'I will vaccinate (VAC)', 'I will not vaccinate (NoVAC)' and 'I do not know if I should get vaccinated (UNK)'. A Chi-square test was performed to determine whether there were differences in COVID-19 vaccination intention according to the general characteristics of the participants, degree of infection control knowledge (Score-K) and practice (Score-P) in response to COVID-19, fears over COVID-19 (Fear-C) and the level of anxiety before (GAD_Before ) and after (GAD_After ) the COVID-19 pandemic. Multiple logistic regression was performed to identify factors affecting VAC and NoVAC by setting the base category as UNK. The p-values of <0.05 were considered statistically significant.

RESULTS

According to the analysis, 44.8%, 18.8% and 36.4% of participants selected VAC, NoVAC and UNK respectively. There were significant differences in vaccination intention according to age, monthly income, residential area, symptoms related to COVID-19, Score-K, Fear-C and GAD_Before . Compared to UNK, < $2000 monthly income, Score-K and Fear-C variables significantly influenced the opinion of VAC. Compared to the answer UNK, monthly incomes of $2000 to $2360 and $2360 to $2730 in residential areas significantly influenced the opinion of NoVAC.

CONCLUSIONS

The variables influencing vaccination intention were monthly income, residential area, Score-K and Fear-C.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

Factors associated with knowledge and vaccination intention for human papillomavirus on trans girls by their main caregiver: A cross-sectional study

Introduction

Trans women are highly affected by the human papillomavirus (HPV) and are at risk of suffering from HPV-related diseases such as oropharyngeal, anal, penile, or neovaginal neoplasia. HPV vaccination seems to be a good strategy to reduce HPV-related diseases, mainly during the early age before the first sexual intercourse, but only cisgender girls are covered by the National Health Services, while some high-risk groups such as trans girls are not included. Achieving a high vaccination rate is important in the adolescent population, but there are many factors that could affect it, such as lack of knowledge about HPV or fear of side effects by patients and main caregivers. The aim of our study is to analyze the knowledge of trans girls' main caregivers about HPV-related diseases in the general population and, in particular, in trans women, as well as factors associated with HPV vaccination intention.

Methods

A cross-sectional study was performed with the collaboration of main caregivers of adolescent trans girls, between 9 and 16 years old, assisted in two reference centers' multidisciplinary Gender Diversity Units. Information was requested through a self-completed questionnaire: HPV-related diseases Knowledge Transwomen questionnaire (HPV-TQ) was elaborated based on a 19-item self-administered questionnaire and score was standardized from 0 to 19 points. Percentage of correct answers was calculated and defined by the group of high scores that showed over 70% correct answers.

Results

A total of 65 main caregivers were included. Almost all main caregivers were mothers with a Caucasian ethnicity. The HPV-TQ average score was 11 (3.7) with an average correct answer of 58.1% (19.6). Only 17/65 (26.1%) of main caregivers were highly knowledgeable in HPV. Of 65 trans girls, 14 were already vaccinated (29.8% of trans girls over 12 years old); 78.5% were not vaccinated and only 21.5% had intentions to be vaccinated. The group with a high score in HPV-TQ had a longer follow-up at the transgender unit, a higher maternal vaccination rate, and a positive family history of HPV-related disease, especially in mothers.

Conclusion

Adolescent trans girls attended to in our units had a low rate and a low intention of vaccination against HPV. Education on and promotion and prevention of transgender HPV-related diseases should probably be implemented to achieve a higher knowledge and vaccination coverage in adolescent trans girls.

Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona

While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona's racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic’s vast impact. Data were collected using a questionnaire designed according to the “survey tool and guidance” provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities’ recommendations, being informed by HCWs or formal information sources, care for others, concern about the country’s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.

Factors Affecting COVID-19 Vaccination Intentions among Patients Attending a Large HIV Treatment Clinic in Trinidad Using Constructs of the Health Belief Model

Persons living with HIV are particularly vulnerable to COVID-19 and understanding the factors influencing their decision to take the COVID-19 vaccine are crucial. Using the Health Belief Model (HBM), our study examined the role of psychological factors in predicting vaccine intention in patients with HIV. The underlying concept of the HBM is that behaviour is determined by personal beliefs about a disease, and access to strategies to decrease its occurrence. A cross-sectional survey using a structured questionnaire was conducted between August and September 2021 at an HIV clinic in Trinidad. Data on the HBM constructs, namely patient's beliefs about the perceived severity and susceptibility to COVID-19, their perceived benefits of taking the vaccine, and external cues to action, i.e., factors that may motivate them to take the vaccine, were collected. Univariate and multivariable logistic regression analyses were used to examine associations and whether the HBM components were predictors of vaccination intention. In this study, 59.9% of patients indicated their intentions to take the vaccine. Females (OR 0.49, 95% CI 0.30-0.81) were less inclined to take the COVID-19 vaccine compared to males, while Indo-Trinidadian patients with HIV (OR 4.40, 95% CI 1.26-15.3) were more inclined to take the vaccine compared to Afro-Trinidadians. Health beliefs such as having confidence in the vaccine (p = 0.001) and believing in its perceived benefits (p = 0.001) were significant predictors of vaccination intention. Patients who were confident about the vaccine were six times more likely to take the vaccine (OR 6.45, 95% CI 2.13-19.5) than persons who were not confident in it. Having adequate information about the vaccine or the knowledge of others who received the vaccine (OR 1.48, 95% CI 1.03-2.11) were significant cues to action influencing their decision. Guided by the HBM, understanding patient's health beliefs is important in the design of tailored interventions to improve vaccine outcomes. The HBM may also be useful in the design of approaches to increase the uptake of critical HIV prevention, and treatment services.

Attitudes toward the pandemic and COVID-19 vaccination intention among German university students and the general population: Results from two cross-sectional surveys

Background

The COVID-19 pandemic has had an impact on nearly all people. Vaccines provide an effective tool to combat the pandemic, however, vaccination hesitancy remains an issue. This study aims to investigate (a) students' attitudes toward the pandemic, (b) potential differences in attitudes between university students and the general population, and (c) to examine predictors of vaccination intention in both samples.

Methods

In this cross-sectional study data from two research projects were analyzed and compared. First, attitudes toward the COVID-19 pandemic in German university students were assessed within a cross-sectional anonymous online survey (March-April 2021, N = 5,639) and analyzed quantitatively and also qualitatively (free text field answers examined positive and negative aspects of the pandemic). Second, data from a cross-sectional survey within the COVID-19 Snapshot Monitoring project (COSMO; 29^th wave of data collection, December 2020, N = 1,387) in the German general population was analyzed. Both samples, were compared in sharedly used variables, regarding attitudes toward the pandemic and vaccination intention, and factors associated with vaccination (logistic regression analyses).

Results

In comparison to the general population, university students were significantly more likely to report being worried about/thinking about the coronavirus and to perceive the coronavirus as overrepresented in the media (all p < 0.001). University students reported a more supportive attitude toward vaccinations in general (students: M = 4.57, SD = 0.85; general population: M = 3.92, SD = 1.27) and a significantly higher vaccination intention (students: n = 4,438, 78.7%; general population: n = 635, 47.7%) than the general population (p < 0.001). Regression analyses revealed that in university students, vaccination intention was significantly predicted by not having children, a supporting attitude toward vaccinations in general, the belief that the coronavirus is overrepresented in the media, and less thinking about/worrying about the coronavirus (all p < 0.05). In the general population, vaccination intention was significantly associated with male gender, higher age, not having children, a supporting attitude toward vaccinations in general, and the belief that the coronavirus is overrepresented in the media (p < 0.05). The qualitative analysis among university students revealed that the most frequently stated positive aspect of the pandemic was to be more flexible due to digitalization (n = 1,301 statements, 22.2%) and the most frequently stated negative aspect was restriction in social life (n = 3,572 statements, 24.2%).

Conclusion

The results indicate differences in the attitudes toward the pandemic between university students and the general population. In addition, differences regarding factors associated with vaccination intention were found in both samples. These results could be important to be considered when designing and targeting vaccination campaigns aiming at informing different population or age groups.

Study registration

DRKS00022424.

What Motivates People to Receive Continuous COVID-19 Vaccine Booster Shots? An Expectation Confirmation Theory Perspective

(1) Background: Abundant evidence has shown that the COVID-19 vaccine booster is highly effective against the Omicron variant. It is of great practical significance to explore the factors influencing the intention to receive COVID-19 booster shots. (2) Methods: We introduced expectation confirmation theory as the basis to construct a model of the factors of the vaccination intention for COVID-19 vaccine boosters. We obtained two batches of questionnaires through Chinese social platforms, with a valid sample size of 572. To test the model, we used SmartPLS3.0 software for empirical analysis. (3) Results: In terms of the characteristics of the vaccine itself, perceived vaccine efficacy and perceived vaccine safety had significant positive effects on expectation confirmation. Regarding vaccination services, perceived vaccination convenience also had a significant positive effect on expectation confirmation. Expectation confirmation positively affected the vaccination intention for the COVID-19 vaccine boosters. Furthermore, the results showed two moderating effects: first, health consciousness negatively moderated the positive effect of perceived vaccine safety on expectation confirmation; second, the time interval since the last dose negatively moderated the positive effect of perceived vaccine efficacy on expectation confirmation. (4) Conclusions: Our research demonstrated that there is an expectation confirmation process for previous COVID-19 vaccines before people consider whether to obtain a booster shot. Perceived vaccine efficacy and perceived vaccine safety remained important factors in receiving COVID-19 booster shots, and our conclusions were consistent with previous literature. In this study, multiple dimensions such as distance and cost were used to measure perceived vaccination convenience. This new variable improve the explanatory power of the convenience of the vaccination service and enrich the variables of the factor model of vaccination intention. In addition, the moderating effects of health consciousness and time interval were found. The findings can provide a theoretical reference for public health institutions to help them understand the formation process of people's intention to receive the COVID-19 vaccine booster.

Predicting Vaccination Intention against COVID-19 Using Theory of Planned Behavior: A Systematic Review and Meta-Analysis

This study systematically analyzed the literature using the theory of planned behavior (TPB) as a theoretical framework to examine the influence of its constructs on vaccination intention against COVID-19. Quantitative studies were searched in PubMed, CINAHL, Web of Science, and Google Scholar following the PRISMA guidelines. The average rate of COVID-19 vaccination intention was 73.19%, ranging from 31% to 88.86%. Attitude had the strongest association with vaccination intention (r₊ = 0.487, 95% CI: 0.368-0.590), followed by subjective norms (r₊ = 0.409, 95% CI: 0.300-0.507), and perceived behavioral control (r₊ = 0.286, 95% CI: 0.198-0.369). Subgroup analyses showed that the pooled effect sizes of TPB constructs on vaccination intention varied across geographic regions and study populations. Attitude had large effect sizes in Asia, Europe, and Oceania, especially among the adult general population, parents, and patients. Subjective norms had large effect sizes in Asia and Oceania, especially among parents and patients. Perceived behavioral control was the most dominant predictor of vaccination acceptance in Africa among patients. These findings suggest that TPB provides a useful framework for predicting intention to receive a COVID-19 vaccine. Hence, public awareness and educational programs aimed at promoting COVID-19 vaccination intention should consider using TPB as a framework to achieve the goal.

Factors Related to HPV Vaccination Intention among MSM in China: A Bayesian Network Model

(1) Background: Men who have sex with men (MSM) are at high risk of human papillomavirus (HPV) infection, and HPV vaccination is the best strategy to prevent HPV infection. Accepting HPV vaccination is an essential factor affecting vaccine promotion among MSM. We aimed to explore the factors related to HPV vaccination intention among MSM and analyze the potential relationship between these factors. (2) Methods: We adopted a nonprobability sampling method to recruit MSM volunteers. Information collection included general demographics, personal behavioral characteristics, knowledge of HPV/vaccine attitudes, and risk threat perception. Bayesian networks (BNs) were used to analyze the data statistically. (3) Results: The BNs showed that perceived HPV risk and attitudes toward vaccine promotion were directly correlated factors, whereas knowledge of HPV/vaccines, a history of HIV testing, and the number of male sexual partners in the past 6 months were indirectly correlated factors. (4) Conclusions: The results of this study illustrate that MSM have a relatively high propensity to receive HPV vaccines. The proposal that strengthening the propagation of HPV and its relevant vaccines, encouraging MSM to undergo regular corresponding tests, and improving their risk perception of HPV infection can be raised to promote HPV vaccination among MSM.

Influence of Psychological Factors on Vaccination Acceptance among Health Care Workers in Slovenia in Three Different Phases of the COVID-19 Pandemic

COVID-19 vaccination acceptance among healthcare workers (HCWs) is very important to control the pandemic and to ensure the safety of HCWs and patients. As psychological factors may affect the decision to be vaccinated, the aim of this study was to investigate the influence of psychological factors on vaccination acceptance in different phases of the COVID-19 pandemic. A cross-sectional study using a web-based survey was conducted among HCWs in Slovenia at the beginning of the pandemic (N = 851), one month later (N = 86), and one year later (N = 145) when vaccines were already available. The results showed that the influence of psychological factors (anxiety, psychological burden, perceived infectability, and germ aversion) was specific for each survey period. At the beginning of the pandemic, vaccination intention was positively associated with anxiety. In the third survey period, anxiety was not exposed as a predictive factor for vaccination intention. However, comparison of vaccination status among groups with different levels of anxiety revealed an interesting distinction within those in favour of vaccination; in the group with minimal levels of anxiety, there was a relatively high share of respondents that were already vaccinated, whereas in the group with severe anxiety, most individuals intended to be vaccinated but hesitated to take action.

Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study

BACKGROUND

The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy.

OBJECTIVE

The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none.

METHODS

This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone.

RESULTS

The majority of participants were male (n=974, 59.3%), White (n=1347, 82.0%), and non-Hispanic (n=1518, 92.4%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95% CI 1.04-1.06), other race (AOR 0.47, 95% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95% CI 2.42-5.73), self-efficacy (AOR 1.75, 95% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs.

CONCLUSIONS

Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted.

COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach

Background

Only 63.8% of Americans who are 18-to-24-years-old have been fully vaccinated for COVID-19 as of June 1, 2022. The Grand Forks County, North Dakota is facing a similar challenge. As of June 2022, 47% of individuals in the 19-to-29-year-old age group are vaccinated. Focusing on unvaccinated individuals in their 20s, Study 1 aims to understand the ways in which receiving COVID-19 vaccines is construed using qualitative interviews; and Study 2 compares the predictors of short-term vaccination intention (i.e., next month) with those of long-term vaccination intention (i.e., three to 5 years) using an online survey.

Methods

For Study 1, we conducted five focus groups and four in-depth interviews via Zoom with a total of 26 unvaccinated individuals in their 20s living in the Grand Forks County. Constant comparison process was used to categorize data into themes and to recognize characteristics of the identified themes. The aim was to develop themes and associated characteristics. For Study 2, we conducted an online survey with a convenience sample of 526 unvaccinated individuals. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between attitudes, perceptions, and beliefs in misinformation and short-term and long-term vaccination intentions, accounting for demographics and socioeconomic status.

Results

In Study 1, two themes were identified: feelings of uncertainty sparked by profits and monetization and navigating the fear of the unknown. In Study 2, an increase in the confidence of COVID-19 vaccines showed significantly higher odds of short-term intention (OR = 2.658, 95%CI 1.770, 3.990) and long-term intention (OR = 1.568, 95% CI 1.105, 2.226). Believing in misinformation had significantly lower odds of short-term intention (OR = 0.712, 95%CI 0.513, 0.990), while more positive attitudes (OR = 1.439, 95% CI 1.024, 2.024), stronger preference in calculating the benefits of COVID-19 vaccines (OR = 2.108, 95% CI 1.541, 2.882), and greater perceived susceptibility (OR = 1.471, 95% CI 1.045, 2.070) to and severity of contracting COVID-19 (OR = 1.362, 95% CI 1.020, 1.820) were significantly associated with higher odds of long-term intention.

Conclusions

Short-term and long-term intentions were predicted differently. Instilling strong confidence in COVID-19 vaccines should increase both short-term and long-term intentions.

The Content of COVID-19 Information Searches and Vaccination Intention: An Implication for Risk Communication

OBJECTIVE

The main objective of this study was to examine the association between COVID-19 information search activities and vaccination intention.

METHODS

Cross-sectional data were collected using online surveys. Independent variables included COVID-19 information search on the (1) science of viral effects of COVID-19 on the body, (2) origin of COVID-19, (3) symptoms and outcomes, (4) transmission and prevention, (5) future outbreak, and (6) policies/procedures to follow. The outcome variable was vaccination intention. A multivariable regression analysis was conducted.

RESULTS

Participants (N = 501) had a mean age of 32.44 ± 11.94 years, were 55.3% female, and 67.9% were white. Most COVID-19 information searches were on symptoms and outcomes (77.7%) and policies/procedures to follow (69.9%). Intention to vaccinate against COVID-19 was higher among participants who searched for information on the science of viral effects of COVID-19 on the body (β = 0.23, 95% CI: 0.03-0.43; P = 0.03) and policies/procedures to follow (β = 0.24, 95% CI: 0.03-0.41; P = 0.02).

CONCLUSIONS

People who searched for information about (1) the science of viral effects of COVID-19 and (2) policies/procedures recommendations also reported higher vaccination intention. Risk communication seeking to increase vaccination should meet the consumers' information demand by prioritizing the scientific rationale for COVID-19 vaccination and by clarifying what policies/procedures are recommended.

The impact of vaccine hesitation on the intentions to get COVID-19 vaccines: The use of the health belief model and the theory of planned behavior model

Object

During the later period of the COVID-19 pandemic, the public has been at risk of the evolving COVID-19 variants and hesitated to be vaccinated against COVID-19 to a certain extent. In this context, the health belief model (HBM) and the theory of planned behavior model (TPB) were used to compare and summarize the relationship between vaccine hesitation/non-hesitation and the intentions to get COVID-19 vaccines and its influencing factors.

Methods

The cross-sectional, population-based online survey was conducted from 14 April to 30 April 2021, and 1757 respondents were recruited to participate in the survey through the Wenjuanxing online survey platform. The HBM and TPB covariate scores were expressed using means and standard deviations and compared between groups using t-tests. Backward multiple linear regression models were used to explore the factors influencing the public's intentions to receive the COVID-19 vaccines.

Results

This study found that educational background is one of the factors influencing vaccine hesitation. Most people with high education do not hesitate (65.24%), while a more significant proportion of people with low education have vaccine hesitation (66.00%). According to HBM, for the vaccine hesitation group, self-efficacy, family advice, and doctor's advice were the most critical factors affecting the public's future vaccination intentions; for the vaccine non-hesitation group, self-efficacy, doctor's advice, and perceived benefits are the most important influencing factors. According to the TPB, the subjective norm is the most critical factor affecting the future vaccination intention of the vaccine hesitation group, and the attitude toward behavior is the most critical factor affecting the future vaccination intention of the vaccine non-hesitation group.

Conclusions

In the context of COVID-19, the public's hesitation on the "current" vaccines will still affect future vaccination intentions. Using HBM and TPB would help health policymakers and healthcare providers formulate intervention plans.

Association of University Students' COVID-19 Vaccination Intention with Behaviors toward Protection and Perceptions Regarding the Pandemic

Background and Objectives: The COVID-19 pandemic is a serious global health problem. Vaccination is suggested to be one of the most efficacious precautionary measures, in combination with other protective behaviors. The purpose of this study was to explore the association of students’ intention to get vaccinated about COVID-19 with protection behaviors and perceptions about the pandemic. Material and Methods: The study sample included 1920 university students who electronically completed two validated questionnaires anonymously and voluntarily from December 2020 to January 2021. Results: Results of the multiple linear regression analysis showed that as the perceived general risk was getting lower, the number of protective behaviors significantly diminished (p < 0.001). Additionally, respondents who believed that they had minor or no personal risk had undertaken significantly fewer preventing behaviors in comparison with participants who thought they had major personal risk (p = 0.006). However, the experience of respondents with people having COVID-19 had statistically significant association with undertaking more preventing behaviors (p = 0.004). Lower general perception of risk had statistically significant association with lower determination to obtain the vaccines of COVID-19 (p < 0.001). Personally knowing someone who had the coronavirus and undertaking more behavioral changes due to the coronavirus situation were significantly related to greater determination to obtain the vaccines of COVID-19 (p = 0.005 and p < 0.001, respectively). Conclusions: The results of this study can provide universities with the appropriate information about the improvement of COVID-19 vaccination strategies.

Determinants of COVID-19 Vaccination Intention among Health Care Workers in France: A Qualitative Study

COVID-19 vaccines are one of the best tools to limit the spread of the virus. However, vaccine hesitancy is increasing worldwide, and France is one of the most hesitant countries. From the beginning of the COVID-19 vaccination campaign, health care workers (HCW) have been prioritized in the vaccination strategy but were also hesitant. This study was conducted to identify and understand the determinants of COVID-19 vaccination intention in the French context, with a view to promoting HCW vaccination. A qualitative study using individual semi-structured interviews of HCWs was carried out at the beginning of the vaccination campaign (January to April 2021) in a French university hospital. Interviews indicated that the vaccination intention of HCWs was influenced by confidence in the proposed vaccines, past experience with vaccines and disease, the opinions and vaccination status of others, and media handling of information related to COVID-19 vaccination. Improving HCW vaccination intention regarding COVID-19 vaccines could be achieved through the dissemination of clear, reassuring, scientific information. Information should be disseminated by HCWs and vaccination experts and adapted to local contexts. To improve the level of confidence and vaccination uptake through a compliance effect, it would be useful to promote positive COVID-19 vaccination experiences and increased rates of immunization.

Comparative Risk: Dread and Unknown Characteristics of the COVID-19 Pandemic Versus COVID-19 Vaccines

This research characterizes risk perceptions of the COVID-19 pandemic and the COVID-19 vaccines based on the dread and unknown dimensions of the psychometric paradigm. We examine if mental risk comparisons of these two risk objects influence risk mitigation behaviors (vaccination intention; vaccine acceptance; preventive behaviors) and emotional responses among unvaccinated and vaccinated Americans. A survey (N = 1532) was conducted based on a nationally representative sample of U.S. adults in May 2021. Results reveal considerable impact of risk comparison, especially along the dread dimension, on the outcomes of interest. In essence, this research reveals critical insights regarding vaccine hesitancy and risk communication about vaccination.

Factors Associated with Vaccination Intention against the COVID-19 Pandemic: A Global Population-Based Study

Several vaccines have been developed for COVID-19 since the pandemic began. This study aimed to evaluate the factors associated with COVID-19 vaccination intention. A global survey was conducted across 26 countries from October, 2020 to December, 2021 using an online self-administered questionnaire. Demographic information, socio-economic status, and clinical information were collected. A logistic regression examined the associations between vaccine intention and factors such as perceptions and the presence of chronic physical and mental conditions. The sample included 2459 participants, with 384 participants (15.7%) expressing lower COVID-19 vaccination intent. Individuals who identified as female; belonged to an older age group; had a higher level of education; were students; had full health insurance coverage; or had a previous history of influenza vaccination were more willing to receive vaccination. Conversely, those who were working part-time, were self-employed, or were receiving social welfare were less likely to report an intention to get vaccinated. Participants with mental or physical health conditions were more unwilling to receive vaccination, especially those with sickle cell disease, cancer history within the past five years, or mental illness. Stronger vaccination intent was associated with recommendations from the government or family doctors. The presence of chronic conditions was associated with lower vaccine intention. Individuals with health conditions are especially vulnerable to health complications and may experience an increased severity of COVID-19 symptoms. Future research should evaluate the effectiveness of interventions targeting the vaccine perceptions and behaviours of at-risk groups. As such, public awareness campaigns conducted by the government and proactive endorsement from health physicians may help improve COVID-19 vaccination intention.

The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n = 182, 14.9%), pharmacists (n = 161, 13.2%) and dentists (n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge (n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine (n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.

HPV Vaccination Intentions of Female Students in Chinese Universities: A Systematic Literature Review and Meta-Analysis

OBJECTIVE

To systematically evaluate the human papillomavirus (HPV) vaccination intentions among female university students in China and establish a basis for improving HPV vaccination coverage.

METHODS

We searched CNKI, EBSCO, JSTOR, MESH or Emtree, Weipu Information Chinese Journal Service Platform, Wanfang Data, China Biomedical Literature Database, PubMed, Embase, Web for the Web of Science, and the Cochrane Library to identify peer-reviewed published research on intentions by female college students in China to receive the HPV vaccination.

RESULTS

A preliminary search of 408 papers resulted in the inclusion of 12 studies, all cross-sectional, of moderate or high quality, with a sample size of 12,600. The HPV vaccination intention rate among Chinese female university students was 16.67% (95% CI: 12.38% to 21.24%). The vaccination intention rates of medical students, non-medical students, and Tibetan students were 30.37% (95% CI: 28.80-34.12%), 15.53% (95% CI: 11.2-20.22%), and 14.12% (95 % CI: 10.59-18.04%), respectively. The vaccination intention rates of the participants with parental education of junior high school and below, high school, and bachelor's degree and above were 15.36% (95 % CI: 11.59 to 17.54%), 17.18% (95 % CI: 12.33% to 19.61%), and 19.81% (95 % CI: 15.61% to 22.25%), respectively. The intention rates of vaccination among residents of first-tier, second-tier, and third-tier cities were 17.64% (95% CI: 12.76-21.63%), 15.39% (95% CI: 11.74-19.82%), and 13.87% (95% CI: 9.36-15.65%), respectively. The results of the meta-analysis were relatively stable with little publication bias.

CONCLUSION

The intention rate of HPV vaccination among female university students in China is low and varies among different populations. There is a need to increase HPV vaccination promotion efforts to improve the intention of female university students to receive the vaccine.

COVID-19 Vaccination Intentions amongst Healthcare Workers: A Scoping Review

A worldwide vaccination programme is the chosen strategy against the COVID-19 pandemic. Vaccine hesitancy, however, forms a threat to achieving a high degree of vaccination. Healthcare workers (HCWs) are exposed to greater risks, in addition to HCWs who care for people with intellectual disabilities (ID). However, little is still known about these groups' vaccine hesitancy. This review aims to provide insight into the intentions and attitudes of HCWs on COVID-19 vaccination, including those who care for people with ID. The search included both types and was conducted in nine databases. A total of 26 papers were identified concerning the vaccine intentions of 43,199 HCWs worldwide. The data were gathered both quantitively and qualitatively. The papers were analysed for all of the themes regarding vaccine intentions, which were: (1) percentages of vaccine willingness; (2) predictors of willingness; (3) attitudes of willingness and hesitancy; (4) sources of vaccination information; (5) contextual factors and changes in COVID-19 vaccine acceptance over time; and (6) future strategies for interventions. Concerns about vaccine safety, efficacy and short- and long-term side effects were the most prominent in HCWs and, therefore, should be addressed in future intervention strategies. Furthermore, interactive interventions are recommended to facilitate exchange, and accurate information should be accessible to target groups on social media platforms.

Identifying conditions for a third dose intention of COVID-19 vaccination in college students: A fuzzy-set qualitative comparative analysis

Background

During the pandemic, a third dose of the COVID-19 vaccine effectively reduces the proportion of severe cases in those infected, but vaccine hesitancy impedes this reasonable prevention method. Epidemic control in China is being tested due to the large population base, especially in crowded places like college campuses. This study aimed to explore the configuration paths of psychological antecedents for college students to receive a third COVID-19 vaccine.

Methods

An anonymous cross-sectional survey was carried out in five universities in Wuhan using convenience sampling. A long version of the 5C 7-point Likert scale was used to measure college students' intention and psychological antecedents on the third dose of the COVID-19 vaccine. A fuzzy-set Qualitative Comparative Analysis (QCA) approach was performed to explore the configuration of conditions to the vaccination willingness.

Results

31.67% of respondents surveyed did not receive their third dose of the COVID-19 vaccine. The score of intention to get the vaccine for college students who did not receive the booster vaccine was 4.93 (±1.68). Average scores of 5.19 (±1.24), 4.35 (±1.75), 4.02 (±1.45), 5.84 (±1.23), and 4.61(±1.32) were reported for confidence, complacency, constraints, calculation, and collective responsibility in them. QCA showed high confidence and collective responsibility playing a central role in third dose vaccination intention. Meanwhile, low confidence and collective responsibility are the core conditions of low vaccination willingness.

Conclusion

Eliminating vaccine hesitancy necessitates focusing on the psychological antecedents of vaccination intentions to identify critical targets for policy and interventions. This study identified trust and collective responsibility are core elements of the psychological antecedents of college students' intention to receive the booster vaccine for COVID-19. To achieve herd immunity as soon as possible, health administration and campus can start with vaccine confidence-building and collective responsibility cultivation to take appropriate actions and measures to improve coverage of the booster vaccination.

Theory of planned behavior explains males' and females' intention to receive COVID-19 vaccines differently

Uptake of COVID-19 vaccines is an important measure to curb the transmission of the coronavirus. Before the vaccines were available, numerous studies found that people had a moderate-to-high intention to receive the vaccines. Several studies have also used the theory of planned behavior (TPB) to predict people’s COVID-19 vaccination intention with three elements (i.e. attitudes, subjective norms, and perceived behavioral control) . However, the vaccination rate falters after the vaccines became available, and there were few updated data documenting people’s vaccination intention and how well TPB can explain their intention. In addition, studies investigating other outcomes found that the predictive utilities of TPB often varied across gender, but such gender differences received little consideration in the literature of COVID-19 vaccination intention. To help fill these gaps, we examined the associations between TPB elements and people’s intention to receive COVID-19 vaccines and the moderation of gender in the context of vaccination campaign. Participants were 405 Chinese citizens. They reported on the three TPB elements and intention to receive vaccines in the coming months. Descriptive results showed that participants’ vaccination intention was moderate. Results of path analysis showed that subjective norms and perceived behavioral control were positively related to vaccination intention for the whole sample. Furthermore, results of multigroup path analysis showed that attitudes were only related to males’, while subjective norms were only related to females’, intention. These findings enhance the utility of TPB in explaining people’s COVID-19 vaccination intention and inform gender-specific strategies to boost males’ and females’ vaccination intention.

Behavioral Intention and Its Predictors toward COVID-19 Booster Vaccination among Chinese Parents: Applying Two Behavioral Theories

The booster vaccination of COVID-19 is being implemented in most parts of the world. This study used behavioral psychology to investigate the predictors of parents' intentions regarding the COVID-19 booster vaccination for their children. This is a cross-sectional study with a self-designed questionnaire based on two behavioral theories-protective motivation theory (PMT) and theory of planned behavior (TPB). A stratified multi-stage sampling procedure was conducted in Nanjing, China, and multivariable regression analyses were applied to examine the parents' intentions. The intention rate was 87.3%. The response efficacy (ORa = 2.238, 95% CI: 1.360-3.682) and response cost (ORa = 0.484, 95% CI: 0.319-0.732) in the PMT, were significant psychological predictors of parents' intentions, and so were the attitude (ORa = 2.619, 95% CI: 1.480-4.636) and behavioral control (ORa = 3.743, 95% CI: 2.165-6.471) in the TPB. The findings of crucial independent predictors in the PMT and TPB constructs inform the evidence-based formulation and implementation of strategies for booster vaccination in children.

The Joint Effects of Social Norm Appeals and Fear Appeals in COVID-19 Vaccine Campaign Posters on Self-Perceived Communication Quality and Vaccination Intention

To understand how different types of cues in vaccine education messages affect attitude toward campaign messages and vaccination intention, this study examined the impact of the presence of social norm appeals (individual vs. group cues) and the presence of fear appeals in coronavirus disease 2019 (COVID-19) vaccine campaign posters on perceived communication quality and vaccination intention. A 2 (social norm appeal: individual cue vs. group cue) × 2 (fear appeal: absence vs. presence) × 3 (repetition) within-subject factorial design experiment was conducted in China. Findings demonstrated that the presence of fear appeals in COVID-19 vaccine campaign posters elicited lower levels of perceived communication quality and vaccination intention than those without fear appeals. The interactive effect of fear appeals and social norm appeals was also found to be significant. Specifically, positive-framed messages (i.e., absence of fear appeals) with group cues and fear appeal messages with individual cues elicited higher perceived information quality and stronger vaccination intention than other types of messages. Understanding how these cues function jointly in COVID-19 vaccine campaign messages will help public health practitioners create more effective intervention strategies.

Promoting COVID-19 Vaccination Using the Health Belief Model: Does Information Acquisition from Divergent Sources Make a Difference?

As a promising approach to stop the escalation of the pandemic, COVID-19 vaccine promotion is becoming a challenging task for authorities worldwide. The purpose of this study was to identify the effective sources for disseminating information on the COVID-19 vaccine to promote individuals' behavioral intention to take the vaccine. Based on the Health Belief Model (HBM), this study illustrated the mechanism of how COVID-19 information acquisition from different sources was transformed into vaccination intentions via health beliefs. Using an online survey in China, the structural equation model results revealed that perceived benefits and cues to action were positively associated with COVID-19 vaccination intentions, and perceived barriers were negatively related to the intentions. However, perceived susceptibility and perceived severity had no significant relationships with the intentions. Moreover, the findings unveiled differences in the effects of acquiring information via multiple sources among traditional media, new media, and interpersonal interactions. Notably, new media and interpersonal interactions were more salient in promoting vaccination intention via health beliefs, compared with traditional media. The findings from this study will benefit health officials in terms of utilizing different information sources in vaccine programs.

Trends in COVID-19 Vaccination Intent, Determinants and Reasons for Vaccine Hesitancy: Results from Repeated Cross-Sectional Surveys in the Adult General Population of Greece during November 2020-June 2021

Vaccine hesitancy is a major barrier to achieving large-scale COVID-19 vaccination. We report trends in vaccination intention and associated determinants from surveys in the adult general population in Greece. Four cross-sectional phone surveys were conducted in November 2020 and February, April and May 2021 on nationally representative samples of adults in Greece. Multinomial logistic regression was used on the combined data of the surveys to evaluate independent predictors of vaccination unwillingness/uncertainty. Vaccination intention increased from 67.6% in November 2020 to 84.8% in May 2021. Individuals aged 65 years or older were more willing to be vaccinated (May 2021: 92.9% vs. 79.5% in 18−39 years, p < 0.001) but between age-groups differences decreased over time. Vaccination intention increased substantially in both men and women, though earlier among men, and was higher in individuals with prograduate education (May 2021: 91.3% vs. 84.0% up to junior high). From multivariable analysis, unwillingness and/or uncertainty to be vaccinated was associated with younger age, female gender (in particular in the April 2021 survey), lower educational level and living with a child ≤12 years old. Among those with vaccine hesitancy, concerns about vaccine effectiveness declined over time (21.6% in November 2020 vs. 9.6% in May 2021, p = 0.014) and were reported more often by men; safety concerns remained stable over time (66.3% in November 2020 vs. 62.1% in May 2021, p = 0.658) and were reported more often by women. In conclusion, vaccination intention increased substantially over time. Tailored communication is needed to address vaccine hesitancy and concerns regarding vaccine safety.

Predicting Intention to Take a COVID-19 Vaccine in the United States: Application and Extension of Theory of Planned Behavior

Purpose

This study aims to apply and extend the theory of planned behavior (TPB) to predict intention to take a COVID-19 vaccine.

Design

Cross-sectional.

Setting

Online.

Sample

Adult US residents recruited from Amazon Mechanical Turk (n = 172).

Measures

Intention to take a COVID-19 vaccine (outcome variable), demographic variables (predictors), standard TPB variables (perceived behavioral control, attitude, and subjective norm; predictors), and non-TPB variables (anticipated regret, health locus of control, and perceived community benefit; predictors).

Analysis

Hierarchical linear regression predicting intention to take a COVID-19 vaccine, with demographic, standard TPB, and non-TPB variables entered in regression models 1, 2, and 3, respectively.

Results

The extended TPB model accounted for 72.5% of the variance in vaccination intention (p < .001), with perceived behavioral control (β = .29, p < .001), attitude (β = .23, p = .043), and perceived community benefit (β = .23, p = .020) being significant unique predictors.

Conclusion

Despite the relatively small and non-representative sample, this study, conducted after COVID-19 vaccines were widely available in the USA, demonstrated that perceived behavioral control was the most robust predictor of intention to take a COVID-19 vaccine, suggesting that the TPB is a useful theoretical framework that can inform effective strategies to promote vaccine acceptance.

From COVID-19 Vaccination Intention to Actual Vaccine Uptake: A Longitudinal Study Among Chinese Adults After Six Months of a National Vaccination Campaign

BACKGROUND

Mass COVID-19 vaccination campaigns have been launched globally, but the translation from vaccination intention to actual vaccine uptake by the public remains unknown, hindering the evaluation of present promotion strategies.

METHODS

Six months after the national vaccination campaign in China, a longitudinal study was conducted among the Chinese adult population, whose vaccination intention has been previously surveyed, to examine the vaccine uptake, the relationship between intention and actual vaccination, and factors associated with actual vaccination behaviors with multiplelogistic models.

RESULTS

Among the total 1047 participants, 81.8% (834/936) of those who had a prior COVID-19 vaccination intention before the campaign actually received the vaccine, while 61.3% (68/111) of those without a prior intention got vaccinated. Having a prior vaccination intention, believing in vaccine safety and receiving frequent recommendations from community sources were significant predictors of vaccine uptake, while the shortage of vaccine supply would reduce the likelihood of getting vaccinated.

CONCLUSIONS

Promotion interventions for vaccination intentions need to be launched well before the availability of the vaccine. Sustaining vaccination attitudes and intentions, reducing barriers (e.g. vaccine safety concerns, accessibility, affordability) and shaping vaccination behavior would be effective in closing the intention-action gap and motivating vaccine uptake.

COVID-19 Vaccine Literacy, Attitudes, and Vaccination Intention Against COVID-19 Among Thai Older Adults

INTRODUCTION

Unvaccinated older adults with COVID-19 are at higher risk for severe illness and complications compared with those have been vaccinated. Vaccine literacy and attitudes are important factors that enhance healthy behaviors and choices, including vaccination intention.

OBJECTIVE

To explore vaccine literacy, attitudes, and vaccination intention toward COVID-19 among Thai older adults and examine associations between vaccine literacy, attitudes, and vaccination intention.

METHODS

This study used a cross-sectional online design. We surveyed 408 older adults who met our inclusion criteria. Participants were recruited online via social media and websites. The survey covered demographic data, vaccine literacy, attitudes, and intention to get the COVID-19 vaccine.

RESULTS

COVID-19 vaccination intention among Thai older adults was high (81.3%). Females and those aged 60-69 years had higher COVID-19 vaccine literacy scores than males (t = -2.120, p < 0.05) and those aged ≥70 years (t = 2.438, p < 0.05). Participants with postgraduate education and those who were health professionals scored higher for vaccine literacy than less educated (t = -3.501, p < 0.01) and non-health professional (t = 5.437, p < 0.001) participants. Those with an adequate income or that had been vaccinated against COVID-19 scored significantly higher for vaccine literacy and attitudes toward the COVID-19 vaccine than participants with an inadequate income (t = 4.626, p < 0.001) or that had not been vaccinated (t = 2.842, p < 0.01). Vaccine literacy (r = 0.219, p < 0.001) and attitudes (r = 0.459, p < 0.001) were significantly associated with vaccination intention.

CONCLUSION

COVID-19 vaccine literacy and attitudes are significant factors related to vaccination intention. Health professionals could play an important role in enhancing vaccine literacy among older adults. Positive attitudes and COVID-19 vaccine literacy may enhance vaccination uptake in older adults.

COVID-19 vaccine acceptance, hesitancy and refusal among Iraqi Kurdish population

OBJECTIVES

Vaccination is one of the most significant public health achievements of humanity. However, a significant portion of the population remains hesitant about vaccine safety, efficacy, and necessity. This study aimed to determine COVID-19 vaccination intention and factors affecting their decision among the general population in the Kurdistan region, Iraq.

METHODS

A cross-sectional survey was conducted online during (April-May 2021), and a total of 1171 participants provided complete and valid answers were enrolled. Data collection was done through online questionnaire through Google Forms. We used binary regression analysis to identify factors associated with COVID-19 vaccination intention.

RESULTS

The majority (53.6%) of the participants were female. Willingness to accept COVID-19 vaccine was low (33 %) of the participants. We found that vaccine hesitancy/resistance was high which was evident for (32%) and (34.9%) of surveyed populations, respectively. Vaccination intention may associate with age, education, and occupation. Furthermore, several factors were associated with hesitancy/resistance: Adverse effects of the vaccine and loss of family members during the pandemic.

CONCLUSIONS

More than half of the study participants refused or were hesitant to have the COVID-19 vaccine, so that Governments and health authorities should improve communication and increase trust.

The Role of Risk Perception in Students' COVID-19 Vaccine Uptake: A Longitudinal Study

Since COVID-19 vaccine uptake was found to be especially low among young adults, the present study investigated COVID-19 risk perception as predictor of COVID-19 vaccination intention and actual COVID-19 vaccine uptake among this age group. More specifically, it was tested whether cognitive risk perception predicts vaccination uptake successively via affective risk perception and vaccination intention. In total, 680 students (65.9% female) between 17 and 28 years participated in this longitudinal online study. COVID-19 cognitive and affective risk perception, COVID-19 vaccination intention, and actual COVID-19 vaccine uptake were measured in t1: November/December 2020, t2: March 2021, and t3: June/July 2021, respectively. The mediation analysis revealed a significant indirect effect of perceived severity at t1 on vaccine uptake at t3 via worry at t1 and vaccination intention at t2. Stronger perceptions of perceived severity of COVID-19 were related to more worry about COVID-19, which led to a higher vaccination intention, which, in turn, increased the chance of COVID-19 vaccine uptake. To increase vaccine uptake among young adults it might be fruitful to emphasize the severity of COVID-19. However, one should take into account that tapping into fear works best when messages also include efficacy statements.